Collaborative Care

Collaborative Care is a team-based approach that requires input from paramedics, EMRs, the patient and the patient’s family to form shared decisions about treatments and care. This holistic approach is predicated on clear and open communication while breaking down hierarchical biases around license level and the traditional BCEHS driver vs attendant care model.  

I. Continuity of Care

Every patient interaction—whether it results in transport, referral, or refusal—must be fully documented to ensure the care history is complete, and subsequent providers have a clear understanding of the care provided.  It is also established law in Canada that documentation is a part of care, and not an afterthought.  

II. Who is responsible for documentation

In a collaborative crew setup, both team members are tasked with documenting the patient encounter. While the primary attendant is responsible for composing the electronic Patient Care Report (ePCR), the content's accuracy and completeness are a joint responsibility shared between the primary and secondary attendant. This collaborative approach ensures that the most pertinent and precise information is included in the patient care record, enhancing the safety and efficiency of patient handovers to our Healthcare Partners (HCP).

To better reflect this teamwork approach, the traditional titles of "attendant and driver" are being phased out in favor of "primary and secondary attendant." This change underscores the importance of cooperative care.

The concept of Crew Resource Management (CRM) has long been integral to paramedicine, aiming to eliminate hierarchical barriers that hinder collaborative patient care. Under the CRM model, it is crucial that we dismantle barriers to teamwork, such as those posed by rank or license levels. Although the highest licensed paramedic (or Emergency Medical Responder, EMR) remains the most responsible for overall call management, their role is to foster an environment where all team members feel empowered to voice their insights and contribute to patient care.

For primary attendants, it is essential to provide their partners with the opportunity to review the ePCR and propose any additions or corrections before finalizing it. This ensures each crew member share accountability for accurately documenting each patient encounter.

Key Points:

• Shared Responsibility: Both crew members collaboratively care for the patient, and therefore both are responsible for documenting the patient’s encounter. The primary attendant MUST give their partner(s) the opportunity to review the ePCR before finalizing.
• Role Evolution: Transitioning from "attendant and driver" to "primary and secondary attendant" highlights the emphasis on teamwork.
• Crew Resource Management (CRM): Encourages dismantling hierarchies to facilitate open communication and collaborative care.
• Empowerment and Responsibility: The primary attendant must encourage input from every member of the team. This ensures all observations and suggestions are considered for patient care before finalizing the ePCR.
• Comprehensive Record Keeping: Both the primary and secondary attendants in a partnered configuration are equally responsible for the accuracy and thoroughness of the patient documentation, supporting safe and effective patient handovers.